Is egg freezing a false promise?

Egg freezing seems like a modern-day medical miracle. But is it all too good to be true? Genea fertility specialist Dr Devora Lieberman investigates.

Medical ‘miracles’ often make headlines, and no area of medicine attracts more interest than women and their fertility. Just as the introduction of the Pill over 50 years ago gave women the ability to delay pregnancy, now egg freezing is promoted as the latest and greatest way for us to take control of our lives both professionally and personally.

Many women I see in their late 30s and early 40s struggling with infertility feel betrayed by their bodies and science. They were under the misapprehension that IVF would always be there for them when they needed it. And now egg freezing is promoted by some as an insurance policy, suggesting that women can delay motherhood while they focus on education, career and finding the right partner. That sounds almost too good to be true. So is it?

As with all matters fertility-related, I believe power lies in knowledge and education.

Does egg freezing work well and reliably?

What any woman who is considering this procedure should ask is: what chance do I have that eggs I freeze now will become babies, and is that chance worth the physical and financial cost?

We’ve been freezing sperm and embryos (eggs that have already been fertilised and developed for a few days) for decades, so the notion of cryopreserving fertility isn’t new. But it’s quite a bit simpler to collect sperm than eggs, and embryos and sperm survive the freeze-thaw process more robustly.

Eggs are the largest cell in the human body, but they are filled with fluid and very delicate structures that are critical to successful embryo development.

I think some background into the procedure would be helpful here.

Every month in a natural ovulatory cycle, a woman will have a number of follicles – the fluid filled cysts that contain immature eggs. In normal ovulation, lots of follicles will begin to develop but with the amount of stimulating hormone produced, only one follicle will grow and ovulate.

With egg freezing, a woman gives herself a much better chance of future success if we freeze lots of eggs, so we augment and control the natural process of ovulation through a series of injections. It usually takes approximately 10 days for follicles to have mature eggs. Ovulation is then triggered and eggs are collected through a needle inserted through the top of the vagina under ultrasound guidance. This procedure takes about 10 minutes, and can be done under general anaesthetic if required.

Those eggs are then frozen using a method called vitrification – essentially snap freezing – and stored until the woman decides to use them.

At that point the eggs are warmed and injected with sperm in a procedure called ICSI (intracytoplasmic sperm injection). They then have to fertilise normally and create embryos and then those embryos have to go on to make babies. Human reproduction is surprisingly complicated and inefficient.

So back to the question of whether or not egg freezing works. The probability of a woman having a live birth using her frozen eggs depends on her age when they were collected and the number of successfully warmed eggs. There are also likely to be differences in success rates among clinics, but I suspect it will be a while before any clinic in Australia has enough experience to quote any meaningful statistics.

How many eggs do you need to freeze?

Data being used widely in the United States shows a 30 year old who freezes 24 eggs has just under 40% chance of having a live baby.

How likely are women to use the eggs?

It’s still early days for this technology, so not enough time has gone by to know just how many women will ever return to use their frozen eggs. One of the busiest egg freezers in the US, NYU’s Nicole Noyes, said recently approximately 10% of her patients have come back.

Should companies be offering to pay for egg freezing?

We all saw the news last year that Facebook and Apple plan to pay for their employees to freeze their eggs, but I worry what that says to young women. Is it telling them that the only way to succeed in their career is to put their plan to have a family on ice? Are we sending them a potentially dangerous message that freezing eggs in their 20s and early 30s guarantees them a baby later in life?

So what do I say to women who are thinking about freezing their eggs?

My position is that women should be educated and informed about their fertility and its finite nature. They should have access to accurate and unbiased information about both their current fertility and their options for managing their fertility into the future. I understand that for some women, the process of having their eggs frozen is just as much about them doing something to take control of their fertility as it is them attempting to secure the chance to have a child later in life. I support that choice as well, as long as it is educated and made without influence from outside sources.

What I hope for all of my patients down the track is that they have no regrets. That they know that they made the best decisions they could at the time that they made them with the information, technology and financial resources they had at the time.

Dr Devora Lieberman is a fertility specialist is holding a free information session on egg freezing in Sydney on Thursday 25 June 2015. You can register here. Devora is a Premium member of Business Chicks. Request her business card and connect with her here.